Provider Demographics
NPI:1083608939
Name:HORN, LISA G (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:HORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MARLOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4030 W HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2287
Mailing Address - Country:US
Mailing Address - Phone:614-442-7550
Mailing Address - Fax:614-442-4100
Practice Address - Street 1:4030 W HENDERSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2287
Practice Address - Country:US
Practice Address - Phone:614-442-7550
Practice Address - Fax:614-442-4100
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2137566Medicaid
H06381Medicare UPIN
OH2137566Medicaid